Unpacking the Broad Landscape of Intraoperative Stressors for Clinical Personnel: A Mixed-Methods Systematic Review

Purpose

The main goals of this mixed-methods systematic review are to identify what types of intraoperative stressors for operating room personnel have been reported in collected studies and examine the characteristics of each intraoperative stressor.

Methods

With a systematic literature search, we retrieved empirical studies examining intraoperative stress published between 2010 and 2020. To synthesize findings, we applied two approaches. First, a textual narrative synthesis was employed to summarize key study information of the selected studies by focusing on surgical platforms and study participants. Second, a thematic synthesis was employed to identify and characterize intraoperative stressors and their subtypes.

Results

Ninety-four studies were included in the review. Regarding the surgical platforms, the selected studies mainly focused on minimally invasive surgery and few studies examined issues around robotic surgery. Most studies examined intra-operative stress from surgeons' perspectives but rarely considered other clinical personnel such as nurses and anesthetists. Among seven identified stressors, technical factors were the most frequently examined followed by individual, operating room environmental, interpersonal, temporal, patient, and organizational factors.

Conclusion

By presenting stressors as multifaceted elements affecting collaboration and interaction between multidisciplinary team members in the operating room, we discuss the potential interactions between stressors which should be further investigated to build a safe and efficient environment for operating room personnel.

Disabled at Work: Body-Centric Cycles of Meaning-Making

A 22-month longitudinal study of (self)employed disabled workers (Following the preference of the lead author who identifies as disabled, the linguistic self-presentation by our participants, the precedent of (Hein and Ansari, Academy of Management Journal 65:749-783, 2022), and the clarification note included in Jammaers & Zanoni's recent review of ableism (Jammaers and Zanoni, Organization Studies 42:429-452, 2021), we chose, and consistently use, the term "disabled employees" throughout the paper. We do so to underscore the premise of the social model of disability, which explains that "people are disabled first and foremost by society, not by their individual, biological impairment. To us this term most clearly highlights that it is society (and possibly organizations) that disable and oppress people with impairments, by preventing their access, integration and inclusion to all walks of life, making them 'disabled'." (Jammaers and Zanoni, Organization Studies 42:429-452, 2021: 448)) models the growing centrality of the body in meaning-making. We inductively explain how body dramas of suffering or thriving initially instigate cycles of meaning deflation and inflation at work. Our disjunctive process model shows that, at the beginning of the pandemic, disabled workers performed either dramas of suffering or on dramas of thriving. However, as the global pandemic unfolded, disabled workers begun crafting composite dramas that deliberately juxtaposed thriving and suffering. This conjunctive process model stabilized meaning-making at work by acknowledging the duality of the disabled body, as both anomaly and asset. Our findings elaborate, and bridge, emerging theories of body work and recursive meaning-making to explain how disabled workers explicitly enroll their bodies to make meaning at work during periods of societal upheaval.

A Postphenomenological Perspective On the Changing Nature of Work

In this essay, I take a postphenomenological perspective on tracing work transformation during the pandemic, arguing that this perspective helps develop novel sensitivities to the nature of work. Postphenomenology brings into high relief the view on work as reliant on sensory performances and embodied relations, complementing already rich accounts of work being reliant on discursive interactions, social order, and spatiality. The focus of postphenomenology on 'non-neutrality' and the multistability of technology provides a useful lens for revealing a multiplicity of changes, encompassing both augmentations and reductions of work experiences and evaluating their consequences for the actors involved. Finally, its attention to the transparency of technology amidst the embodied experiences gives a handle on the role of materiality in the performance of work and may be taken up as informing design efforts. A case study vignette of physiotherapy work during lockdown is offered as an illustration of applying some of the postphenomenological ideas.

Local Adaptation Without Work Intensification: Experimentalist Governance of Digital Technology for Mutually Beneficial Role Reconfiguration in Organizations

This 1.5-year ethnographic study of a U.S. medical center shows that avoiding loss of autonomy and work intensification for less powerful actors during digital technology introduction and integration presents a multisited collective action challenge. I found that technology-related participation problems, threshold problems, and free rider problems may arise during digital technology introduction and integration that enable loss of autonomy and work intensification for less powerful actors. However, the emergence of new triangles of power allows for novel coalitions between less powerful actors and newly powerful third-party actors that can help mitigate this problem. I extend the political science perspective of experimentalist governance to examine how a digital technology-focused, iterative collective action process of local experimentation followed by central revision can facilitate mutually beneficial role reconfiguration during digital technology introduction and integration. In experimentalist governance of digital technology, local units are given discretion to adapt digital technologies to their specific contexts. A central unit composed of diverse actors then reviews progress across local units integrating similar digital technology to negotiate a new shared understanding of mutually beneficial technology-related tasks for each group of actors. The central unit modifies both local routines and the technology itself in response to problems and possibilities revealed by the central revision process, and the cycle repeats. Here, accomplishing mutually beneficial role reconfiguration occurs through an experimentalist, collective action process rather than through a labor-management bargaining process or a professional-led tuning process.

“Our Flight Suits are not Just Plain Blue”: The Co-Production of Coordination and Bodies in a Military Air Display Squadron

While prior investigations of organizational coordination have mainly focused on cognitive processes, this article brings the physical and symbolic body more centrally into the phenomenon. Mobilizing the ‘strong’ practice programme, we explore how organizational coordination practice and bodies co-produce each other. Our study is an empirical qualitative analysis of Patrouille de France, a military air display squadron. By successively zooming in and out from pilots’ doings and sayings, we reveal three body-related threads (training, sensitizing, and distinguishing) by which organizational coordination and bodies co-produce each other. We especially point to technical and physical capital, proprioception, kinaesthesia, embodied awareness of co-presence, and the symbolic (re)presentation of bodies as embodied aspects of the actors’ habitus structured by and for coordination. Our findings have implications for our understanding of organizational coordination by showing that there is more to bodies in coordination than just embodied cognition or communication. They also further coordination literature by emphasizing that coordination practice includes organizationally structured bodywork aimed at enhancing bodies; bodywork that is not limited to learning the practice but crucial to maintaining actors in that practice.

Organizations Decentered: Data Objects, Technology and Knowledge

Data are no longer simply a component of administrative and managerial work but a pervasive resource and medium through which organizations come to know and act upon the contingencies they confront. We theorize how the ongoing technological developments reinforce the traditional functions of data as instruments of management and control but also reframe and extend their role. By rendering data as technical entities, digital technologies transform the process of knowing and the knowledge functions data fulfil in socioeconomic life. These functions are most of the times mediated by putting together disperse and steadily updatable data in more stable entities we refer to as data objects. Users, customers, products, and physical machines rendered as data objects become the technical and cognitive means through which organizational knowledge, patterns, and practices develop. Such conditions loosen the dependence of data from domain knowledge, reorder the relative significance of internal versus external references in organizations, and contribute to a paradigmatic contemporary development that we identify with the decentering of organizations of which digital platforms are an important specimen.

From Lock-In to Transformation: A Path-Centric Theory of Emerging Technology and Organizing

We offer a path-centric theory of emerging technology and organizing that addresses a basic question. When does emerging technology lead to transformative change? A path-centric perspective on technology focuses on the patterns of actions afforded by technology in use. We identify performing and patterning as self-reinforcing mechanisms that shape patterns of action in the domain of emerging technology and organizing. We use a dynamic simulation to show that performing and patterning can lead to a wide range of trajectories, from lock-in to transformation, depending on how emerging technology in use influences the pattern of action. When emerging technologies afford new actions that can be flexibly recombined to generate new paths, decisive transformative effects are more likely. By themselves, new affordances are not likely to generate transformation. We illustrate this theory with examples from the practice of pharmaceutical drug discovery. The path-centric perspective offers a new way to think about generativity and the role of affordances in organizing.

Space and Sensemaking in High-Reliability Task Contexts: Insights from a maritime mass rescue exercise

The spatial environment shapes sensemaking in complex situations. While we know that actors in high-reliability task contexts often have a certain degree of control over their spatial environment, it remains unclear how they enact it and which effect this has on their sensemaking. In this paper, we use micro-ethnographic video data from two maritime mass rescue exercises to fill this gap. We find that actors that are under a high cognitive load enact space incidentally and fail to re-enact their spatial environment when problems arise. Instead, actors engage in micro-activities that temporarily mitigate the problems created by their space enactment. We develop a model on space and sensemaking in high-reliability task contexts that distinguishes between unenacted, enacted and lived space. Our findings point towards nested sensemaking, where the enacted spatial environment becomes part of the overall ‘story’ of an operation. Our findings have implications for our understanding of space and sensemaking in high-reliability task contexts, provide opportunities to improve high-reliability organizations’ performance and add to research on space and organising.

Interpersonal Connectivity Work: Being there with and for geographically distant others

In this paper we ask how interpersonal connectivity can be achieved at a geographic distance. This is in contrast with extant literature that focuses on states of connectivity rather than the work needed to achieve it. We draw on phenomenological ideas of embodiment, presence and distance, in combination with empirical material from an extreme remote work context – telenursing in Australia. The nurses we interviewed triage patients entirely by telephone. We argue that even with low social and technical connectivity, interpersonal connectivity is achievable through skilful work with technology. We explore the work that goes into ‘being there with and for distant others’ by combining the phenomenological concepts of ‘maximal grip’ and ‘intentional arc’ with empirical examples. We propose that interpersonal connectivity is oriented empathetically towards both the other person and agentically towards the joint situation. We thereby develop a conceptual model of interpersonal connectivity work, which argues that distributed workers need to skilfully balance the dualities of freedom/control and nearness/farness to achieve interpersonal connectivity. Achieving and maintaining interpersonal connectivity is an important skill, particularly for leaders who operate in work contexts that are increasingly distributed, flexible and temporary.